Neurological Disorders: Acute Confusional State

Introduction

Acute Confusional State is also called as delirium or acute encephalopathy and as the name implies this is a health situation where a person presents with confusion in an acute setting.

Acute setting refers where something started progressed and resolved rapidly or fairly rapidly unlike a chronic condition like dementia which generally presents slowly and persists for long time.

What causes these confusional states?

The following are some of the common examples;

• Head injuries
• Neurological Infections like encephalitis
• Systemic infections like pneumonia, UTI
• Seizures - during or after the attack
• Certain types of strokes/mini strokes
• Medication side effects e.g. anti cholinergic drugs like atropine
• Toxins like cocaine
• Electrolyte abnormalities like hyponatremia
• Endocrine disorders like thyroid gland diseases
• Organ failures like kidney or liver failures
• Psychiatric disorders like acute mania/psychosis etc

Clinical presentation

Patients are found typically disoriented and confused. In a typical full blown delirium state there are autonomic manifestations too including rapid heart rate (tachycardia, blood pressure changes, temperature changes etc). Patient’s sleep cycle is also disrupted. There may be psychiatric manifestations including severe agitation, combativeness, hallucinations, delusion etc.

Diagnosis

The diagnosis of this condition is clinical. Once clinical diagnosis is made then we look for what triggered it. Generally a bunch of investigations are required including (decided on case to case bass);

• A picture of the brain like a CAT scan or MRI scan
• Blood tests looking at electrolytes, cell count etc
• EEG
• Urine analysis
• Chest x ray
• CSF (cerebrospinal fluid) analysis
• Culture of body fluids
• Measurement of blood medication or toxin concentration etc

Treatment

The treatment of this condition is focused on the delirious state as well as what caused it. Patients are admitted to hospital preferably to the intensive care unit setting and monitored closely.

The specific treatment depends upon what caused it; antibiotics are given for infections, AEDs (antiepileptic drugs) for seizures, removal of the toxins, adjustment of the medications, rectifying the electrolyte balance etc. The prognosis of the patiet mostly depends upon what caused this condition.

A neurologist and/or a family doctor is commonly involved in the care of patients with acute confusional state.



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